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How should airways resistance be measured in young children: mask or mouthpiece?
1Academic Dept of Paediatrics, City General Hospital (North Staffordshire Royal Infirmary), Stoke-on Trent, UK.
Insights
Airway resistance measurements in children using the interrupter technique showed similar repeatability with mouthpieces and face masks. However, results differed significantly, meaning the methods are not interchangeable for clinical use.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Accurate airway resistance measurements are crucial for diagnosing and managing pediatric respiratory conditions.
- The interrupter technique (MicroRint) is a common method, but its application using different interfaces (mouthpiece vs. face mask) in young children requires evaluation.
Purpose of the Study:
- To compare the reproducibility and acceptability of airway resistance measurements obtained via the interrupter technique using a mouthpiece versus a face mask in children aged 4-7 years.
Main Methods:
- Fifty children performed Rint measurements using both a mouthpiece and a face mask with an integral mouthpiece.
- Reproducibility was assessed using intraclass correlation coefficients (ICC) and coefficients of variation.
- Acceptability was evaluated through participant preference.
Main Results:
- Both methods demonstrated comparable repeatability (ICC, coefficient of variation).
- Mean Rint values were significantly lower with the mouthpiece (0.81 kPa·L⁻¹·s) compared to the face mask (0.88 kPa·L⁻¹·s).
- Despite small mean differences, the methods were not interchangeable, as confirmed by ICC and limits of agreement.
Conclusions:
- Repeatable airway resistance measurements can be obtained from young children using either a mouthpiece or a face mask with the interrupter technique.
- Significant clinical and statistical differences exist between the two methods, precluding their interchangeable use.
- While children preferred the face mask, it was more time-consuming and did not yield more repeatable results.
Abstract:
The reproducibility and acceptability of airways resistance measurements using the interrupter technique (MicroRint) obtained using a mouthpiece were compared with those using a face mask. Fifty children aged 4-7 yrs performed four sets of six Rint measurements; two using a mouthpiece and two using a face mask with integral mouthpiece. Complete data were obtained from 45 (90%) children using the mouthpiece and 43 (86%) children using the mask. The two methods were equally repeatable with comparable intraclass correlation coefficients (ICC) and coefficients of variation. Mean Rint values obtained using the mouthpiece were significantly lower than those using the face mask ((mean+/-SD) mouthpiece=0.81+/-0.18 kPa x L(-1) x s, mask=0.88+/-0.24 kPa x L(-1) x s p=0.0002). Although the mean paired differences between the two methods were small (0.07 kPa x L(-1) x s), the ICC and limits of agreement confirmed that the two methods could not be used interchangeably. Sixty-seven per cent of children preferred the face mask but this was more time-consuming (p = 0.03). Children did not produce more repeatable results using their preferred method, nor did they improve with practice. Repeatable airway resistance measurements using the interrupter technique can be obtained from young children using either a mouthpiece or a face mask, but there are significant clinical and statistical differences between the results obtained.